Dr. K. Jang in the Vancouver Sun

Canada unprepared for refugees’ mental health issues, experts say

Many Syrians, including children, have ‘witnessed war, murders and sexual assaults’

By Jeff Lee, Vancouver SunNovember 24, 2015

Dylan Mazur executive director of Vancouver Association for the Survivors of Torture is worried there are no plans to provide mental health services to the incoming Syrian refugees Metro Vancouver is expecting in the next few months.

Photograph by: Ric Ernst , VANCOUVER SUN

Canada may be ignoring one of the biggest challenges Syrian refugees face, mental health care, as it prepares to accept women, children and families in an unprecedented response to the humanitarian crisis caused by the four-year-old civil war.

On Tuesday the Trudeau government unveiled its plans for resettling as many as 25,000 displaced Syrians across the country by the end of February, taking them from established refugee camps in Lebanon and Turkey. As many as 3,000 may be resettled in British Columbia.

But while settlement societies across the country are gearing up to provide language services, job-finding and housing, they aren’t being equipped to help the refugees deal with the mental trauma they have suffered.

And that is no small issue, according to advocates, who say as many as 80 per cent of children and adults who will arrive also come packed with some powerful mental health problems, including post-traumatic stress disorder.

“You are going to see people who have come in with elevated levels of PTSD,” said Dylan Mazur, the executive director of the Vancouver Association for Survivors of Torture. “You are going to see people who have witnessed war, murders and sexual assaults, and many of them are children.”

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Refugees to Canada are given access to basic medical health services under the federal Interim Health Program. But that doctor-prescribed, fee-for-service program doesn’t support community mental health and group therapy programs that settlement service providers say refugees need.

Citizenship and Immigration Canada said it doesn’t fund health care services through its settlement funding. Under the IFH program, a doctor can refer a person to a psychologist or psychiatrist for a maximum of 10 sessions.

But Mazur said that clinical service isn’t designed to deal with the group trauma conditions affecting many refugees.

“On a wide scale there is no community setting to provide the IFH program in the numbers it is needed,” he said.

There is a shortage of psychologists and psychiatrists trained in dealing with PTSD and serious mental trauma, said Kerry Jang, a University of B.C. professor of psychiatry and Vancouver city councillor.

Until last year Citizenship and Immigration Canada indirectly funded some forms of trauma treatment. It contracted with provincial governments to administer settlement funding. B.C. in turn created a separate stream for trauma funding for VAST and other groups.

However, last year the Harper Conservative government dramatically cut back funding of settlement services and repatriated the program to Ottawa, cutting out the province. As a result, VAST lost all of its federal funding. B.C. stepped in through the Jobs, Tourism and Skills Training Ministry, offering $180,000 for trauma counselling. However, that money is available only to treat refugee applicants who are already in B.C.

“While we’re able to serve refugee claimants, we are not able to assist the government-assisted or privately sponsored refugees,” said Mazur, who is grateful for the provincial support.

MOSAIC, a Vancouver immigrant settlement services society, has just started a fee-for-service, one-on-one counselling program with UBC, said Sherman Chan, the director of family and settlement services.

“But there needs to be more culturally-appropriate ways of providing psychological counselling services for groups,” he said. “CIC is really clear; all those monies are used for certain purposes but not for mental health or trauma counselling.”

Jang said Ottawa’s failure to fund community mental health services will hurt resettlement of the Syrian refugees.

“Psychiatric services should be available to anyone who needs it,” he said. “It is ludicrous that we don’t have appropriate mental health services available for these refugees.”

UBC has just started development of a mobile application that will be specifically for helping Syrian refugees deal with PTSD, Jang said. The developers are awaiting information on which camps the refugees are from and what languages they speak. Such mobile programs have already been used with success in some refugee camps but need to be tailored to local populations, he said.

The demand for mental health services is not in dispute. In October the Migration Policy Institute issued a report showing that almost half of all children it surveyed in a Turkish refugee camp displayed symptoms of PTSD, 10 times higher than among children elsewhere in the world.

It said that 40 per cent of the estimated four million who have fled Syria since 2011 are under the age of 12. Of the children it surveyed in Turkey’s Islahiye camp, 79 per cent had experienced a death in the family, 60 per cent had seen someone get kicked, shot at or physically hurt, and 30 per cent had themselves been kicked, shot at or physically hurt.

Another report by the War Trauma Foundation estimates as many as 65 per cent of Syrian refugees, both adults and children, may suffer from PTSD, Mazur said.

The Vancouver Sun requested an interview from Citizenship and Immigration Canada. However, the department responded with an email saying that it “does not fund health care services through settlement funding.”

Instead, it said it puts its settlement funding toward “programs and activities that help new Canadians integrate and successfully participate in our economy, such as official language classes and job training.”

It said that successful government-sponsored refugees from war, violence and persecution get full medical coverage under the IFH program. It referred The Sun to a website that contained billing code information for health professionals.

“The difference is that with IFH they are going to sit in a room with a psychologist for 10 sessions, as opposed to accessing a community setting where people have experience having survived political violence,” Mazur said.

“It is not to say that everyone will have trauma; people are incredibly resilient, but the response can’t be just sitting (one-on-one) in a room with a psychologist.”